I needed a place to vent and this is the only place i can think of to do it. Sorry in advance.

Today I called my insurance company (Cigna) to see what the medical director determined about my approval/denial. They denied my claim based on the I had 63 days of nutritional visits instead of 89 days whatever that means. I went to the nutritionist once in August, once in September and once in October. I went for 90 consecutive days, I did my 3 visits. Also, something about medically observed visits, what is that? The customer service representative can't tell me exactly what is necessary to get an approval.

I would like to if I need to start this process over again or if I can do one more visit with the nutritionist as the final visit.

Where the hell do I go from here?

I'm at a lost. And I don't have the patience to wait for when my surgical coordinator has the time to call me with an explanation or solution.

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Edited December 20, 20169 yr by Finding_me

From what I've read on other forums, appeal the decision. Call Cigna and be persistent. If you've got all the right documentation, it should be good. I've got Cigna too, but haven't gotten to that point where you're at yet. I hope it clears up quickly for you. Hang in there.

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Edited December 20, 20169 yr by DCast78

It's posts like these that make me so glad that I decided, and am able, to pay out of pocket. IMO, it seems to be worth the extra money for the time and frustration saved.

If you have the ability, I say forget insurance (I realize this isn't an option for many folks).

I don't have Cigna, but my insurance also requires 90 days which is over 4 visits. The first visit is day 1 and day 30 is the 2nd visit, and day 60 is the 3rd. The last and 4th visit would be at least day 90. Maybe call and see if you can resume and have another follow up with the nutritionist for your final visit so there is no need to repeat the process.

Vent all you need! This process is definitely frustrating!

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Edited December 20, 20169 yr by Flippista

I needed a place to vent and this is the only place i can think of to do it. Sorry in advance.

Today I called my insurance company (Cigna) to see what the medical director determined about my approval/denial. They denied my claim based on the I had 63 days of nutritional visits instead of 89 days whatever that means. I went to the nutritionist once in August, once in September and once in October. I went for 90 consecutive days, I did my 3 visits. Also, something about medically observed visits, what is that? The customer service representative can't tell me exactly what is necessary to get an approval.

I would like to if I need to start this process over again or if I can do one more visit with the nutritionist as the final visit.

Where the hell do I go from here?

I'm at a lost. And I don't have the patience to wait for when my surgical coordinator has the time to call me with an explanation or solution.

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On my first visit with my surgeon I was given a check list of what my insurance requires for approval. They went down the list with me and we discussed what else needed to be done before submitting to insurance. If you needed 89 days of nutritional visits and you only had 63 someone in your surgeon's office messed up. It isn't the insurance companies fault.

Most surgeons employee a staff that can make sure everything necessary for approval is sent to the insurance company. It's a total waste of time to send it in if everything isn't there. Do you have to use this surgeon? They sound like they aren't aware of how the process works.

@ I was told by Cigna that my doctor needs to have a peer to peer with the medical director.

@@White Sale If I had the funds, I would. On the plus side the way my policy with Cigna is I have no out of pocket expenses what so ever.

@@Flippista it's aggravating that sometimes we need a microscope to read the fine print. Argh. I guess on a positive note at least it's not the medical side that is giving me a problem.

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It's posts like these that make me so glad that I decided, and am able, to pay out of pocket. IMO, it seems to be worth the extra money for the time and frustration saved.

If you have the ability, I say forget insurance (I realize this isn't an option for many folks).

I agree.

I went through similar struggle. I decided to opt out of surgery in the USA and went to Mexico.

Best decision ever! Sleeve only 4k

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You have the right to APPEAL their denial. I do medical billing and each insurance has strict guidelines and you must follow them exactly..what I would do first is call them and ask them to send you or you should be able to go online (more importantly your Dr's office should know what your specific insurance requires) ask for copy of weight loss surgery guidelines then make sure the insurance has ALL of those records....Sometimes it's a matter of your insurance nor receiving everything. But once you know exactly what they require then Appeal the denial but make sure you have everything exactly or they will deny it again. In the end if it's denied again after everything has been followed then you can seek legal assistance but normally appeal works.....

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I needed a place to vent and this is the only place i can think of to do it. Sorry in advance.

Today I called my insurance company (Cigna) to see what the medical director determined about my approval/denial. They denied my claim based on the I had 63 days of nutritional visits instead of 89 days whatever that means. I went to the nutritionist once in August, once in September and once in October. I went for 90 consecutive days, I did my 3 visits. Also, something about medically observed visits, what is that? The customer service representative can't tell me exactly what is necessary to get an approval.

I would like to if I need to start this process over again or if I can do one more visit with the nutritionist as the final visit.

Where the hell do I go from here?

I'm at a lost. And I don't have the patience to wait for when my surgical coordinator has the time to call me with an explanation or solution.

Sent from my iPhone using the BariatricPal App

On my first visit with my surgeon I was given a check list of what my insurance requires for approval. They went down the list with me and we discussed what else needed to be done before submitting to insurance. If you needed 89 days of nutritional visits and you only had 63 someone in your surgeon's office messed up. It isn't the insurance companies fault.

Most surgeons employee a staff that can make sure everything necessary for approval is sent to the insurance company. It's a total waste of time to send it in if everything isn't there. Do you have to use this surgeon? They sound like they aren't aware of how the process works.

Actually this is my third surgeon, I did the actual requirement at another office before transferring to this one. I know where to place the blame on this it's just frustrating because I had my suspensions that they were being sneaky about something.

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I would not pay our if pocket...that is what the inurance is hoping u will do is give up so they don't have to pay for it....the laundry list they require makes only the serious candidates follow thru that's why they do it....but like I said get their requirements and then appeal...

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I would not pay our if pocket...that is what the inurance is hoping u will do is give up so they don't have to pay for it....the laundry list they require makes only the serious candidates follow thru that's why they do it....but like I said get their requirements and then appeal...

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And this is why I'm going to see what happens with the peer to peer. If I can complete the visits then fine if I have to start over with the nutritional visits, at least it's not the medical problems or weight.

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I was also extremely frustrated after being denied twice. For the external appeal which you do after 2 denials I hired Lindstrom Advocacy group, and my insurance approved me even before it reached a third party. They are you fight, they give up.

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I was also extremely frustrated after being denied twice. For the external appeal which you do after 2 denials I hired Lindstrom Advocacy group, and my insurance approved me even before it reached a third party. They are you fight, they give up.

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Wait there's groups that fight for this??!?!?!

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https://wlsappeals.com

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Very nice people, they charge $600.

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I have Cigna and was approved in a matter of two or so days. My first dietitian visit was also in August and I went September and October before they sent it to insurance. I also needed three months of them based on my Cigna requirements but the dietitian's office stated that they wouldn't need 90 days but rather three months going to them and thankfully they ended up being right because I was approved. As far as medically observed visits they are likely your monthly primary care physician's appointments. Each month I had to have a dietitian visit and a visit with my doctor. Did you have these visits with your doctor each month that you saw the dietitian? I'm sorry that you are experiencing this . Hopefully the doctor's office is able to resubmit and it'll be approved.

I would not pay our if pocket...that is what the inurance is hoping u will do is give up so they don't have to pay for it....the laundry list they require makes only the serious candidates follow thru that's why they do it....but like I said get their requirements and then appeal...

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Perhaps.

Because I was self-pay and my "clean" medical history, my surgeon only had me do the bare minimum for pre-op testing : chest x-ray, 2 blood labs, and an EKG.

He had a whole checklist of about 15 or so pre-op tests and only checked the three.

I also negotiated with the hospital for lower costs. I am staying overnight, so they get the lion's share, about 2/3, of the total cost.

tl;dr: healthcare providers may have incentive to do extra "work" on insured patients because they'll get paid well for it.

Either way, it is neither a good nor efficient nor fair healthcare system.